Laparoscopic cholecystectomy, which has become the gold standard for gallbladder surgery, is a surgery performed under general anesthesia and its duration is about 45 minutes.
In gall bladder surgery, the most frequently asked question is whether only stones are removed or is the question of removing all of the gallbladders.
With the help of 4 holes just like keyholes smaller than 1 cm, the gall bladder is completely removed in this surgery. A surgical method of removing only stones is not available.
Liver function tests are performed before gallbladder surgery. These tests are determined by the examination of the blood sample taken. The normal range of substances like Bilirubin, ALT, AST, ALP, GGT and albumin found in the blood indicates that the liver and bile ducts are healthy.
Gallbladder diseases are diagnosed by ultrasound which is the cheapest and easiest method today. The presence of stones or sludge in the gallbladder, thickening of the wall of the gallbladder, accumulation of fluid and edema around the gallbladder are the findings that indicate inflammation of the gallbladder.
The gallbladder is a hollow organ that is the size of a pear. It is in the upper right part of the abdomen and under the liver. As the name implies, the task is to store the bile produced by the liver for digestion. Formations such as stones, sand or polyps may develop in the gallbladder over time. The most common gallbladder problem is gallstones.
WHAT IS BILE? WHAT IS THE PURPOSE OF THE GALLBLADDER IN THE HUMAN BODY?
Bile is a body fluid that is synthesized in the liver and transferred to the duodenum through the bile ducts. In order for food to be melted and digested, it acts as a detergent on foods and separates the fatty parts and divides them into small pieces. It is synthesized between half a liter and one liter per day. Most of the bile produced in the liver is stored in the gallbladder. The liquid portion of the bile stored in the gallbladder is absorbed and made more viscous. After the meal, the gallbladder is stimulated, the pouch is contracted and empties the bile in the duodenum.
HOW DOES GALLSTONE FORM IN GALL BLADDER?
The gallbladder is a pear-shaped organ that normally has a volume of about 50 mL and stores the remaining bile from the bile ducts. In the meantime, it absorbs the water portion of the bile and makes it thick. At this stage, the cholesterol in the bile crystallizes if it is too much. The process at this stage can be likened to coffee and its grounds. Over time, cholesterol crystals combine to form biliary sludge first and then combine with other glycoproteins in the bile to form gallstones.
DO ALL TYPES OF GALLSTONES CAUSE PAIN?
No. In fact, one out of every 7-8 people in the society may develop stones in the gallbladder in older ages and the majority of these stones do not cause pain and indigestion. In numerical terms, 11-36% of people over 40 years of age have gallstones in the community, and only 3% of these patients are inflamed by gallstones annually.
WHAT ARE THE SYMPTOMS OF PRESENCE OF GALLSTONES IN A GALLBLADDER?
Pain in the right upper abdomen is evident in almost every patient. However, it can cause abdominal pain, nausea and sometimes even vomiting, especially after fatty meals. Generally, the pain begins within 1 hour, lasts for 3-4 hours and resolves within 2 hours. This condition, called bile colic, may sometimes be confused with gastritis and gastric ulcer, or the patient may assume that the kidney stone is passing. If these complaints are accompanied by anorexia and fever, it can be suspected that the gallbladder is inflamed. Rarely, some of the stones in the gallbladder come out of the gallbladder and fall into the main bile duct. In this case, jaundice is likely to develop.
IF I HAVE ABDOMINAL PAIN AND OTHER COMPLAINTS, WHAT SHOULD I DO FIRST?
If the gallbladder stone is suspected as a result of the examination in these patients, ultrasonography should be used as an initial examination with more than 90% diagnostic accuracy.
WHAT IS 5F?
5F formed by taking the initials of Female, forty, fatty, fertile ,and fair states that gallbladder stones are more common in obese blonde women over 40 years of age with high fertility.
I HAVE GALLSTONES IN MY GALLBLADDER, DO I HAVE TO BE TREATED?
In line with the principles of Evidence-Based Medicine and good clinical practice, first of all, the patient’s complaints are examined to answer this question. That is, if the diagnosis is made by an ultrasound examination in the check-up program, although the patient has no complaints and the stone is smaller than 2 cm, the patient may not be operated.
IN WHICH CASES GALLSTONES ARE NECESSARILY OPERATED?
Gallbladder stones that are encountered in childhood are definitely operated. In addition, in some blood diseases (such as sickle cell anemia), stones in the gallbladder should be operated. Surgery is inevitable in patients who have long been known to have stone in the gallbladder and have been repeatedly inflamed and therefore become unable to function.
I HAVE GALLSTONES AND I DO NOT WANT TO HAVE AN OPERATION. WHAT SHOULD I DO? WHAT ARE THE DISADVANTAGES OF SURGERY?
If you have stones in your gallbladder and these stones cause pain after fatty meals, you can maintain your life with a fat-poor diet. However, if this application does not prevent inflammation of the gallbladder and one day the gallbladder is inflamed because of stone, the rate of which is 3% per year, then you may have to undergo emergency surgery. An important risk is that the stones in the gallbladder may fall into the main bile duct and block the bile ducts. In such a case, jaundice occurs, and the pancreas may be damaged. Microbial inflammation of the main biliary tract is a disease that cannot be easily treated and may require long-term hospitalization.
I HAVE NOT GALLSTONES IN MY GALLBLADDER BUT I HAVE BILIARY SLUDGE, WHAT SHOULD I DO?
The presence of biliary sludge in the gallbladder and the inflammation of the biliary sludge is considered in the same perspective as the formation of stones in the gallbladder. In symptomatic patients with gallbladder sludge and not operated, it should be known that the risk of inflammation of the pancreas is higher.
I AM PREGNANT AND I HAVE GALLSTONES OR BILIARY SLUDGE IN MY GALLBLADDER, WHAT SHOULD I DO?
The gallbladder and bile ducts become lazy during pregnancy and their diameters expand. In pregnancy, the incidence of sludge in the gallbladder increases with the effect of estrogen and progesterone. In this case, it is important in which quarter of the pregnancy the patient is. In the first trimester, if the patient complains of abdominal pain, nausea and vomiting, she is hospitalized and the possibility of inflammation of the gallbladder is investigated. During this period, it is usually treated with medication and the patient’s operation rationale is evaluated by considering the risks on the mother and child. In the second trimester, a similar procedure is used for microbial inflammation of the gallbladder stones; however, dilatation of the biliary tract is prominent during this period, which increases the risk of infection. If the gallbladder stone fixation in the last trimester does not cause any complaints and the stones are small, it waits until delivery. If an inflamed gallbladder is involved, the patient is treated by hospitalization.
HOW IS THE GALLBLADDER SURGERY OPERATED?
Gall bladder surgeries, which were previously performed in open technique, are now performed by laparoscopic method at a rate of over 95%. In this operation, gall bladder is ablated with instruments placed through 4 holes which are only 1 cm in the abdomen. The operation duration is usually less than 1 hour. In the early postoperative period, the patient can stand up, walk and eat. In the early postoperative period, the patient can stand up, walk and eat. After the operation, an average of 2-3 days of hospitalization is sufficient, and patients are often discharged on the next or the other next day of surgery.
WHAT ARE THE SURGICAL RISKS?
As in every surgery, surgical risks are examined under two main headings: patient risks and surgical risks. Regardless of where and how the patient is operated, some additional problems such as blood pressure, diabetes, heart, lung, and kidney diseases are the causes of the patient’s risk, but none of them is an absolute obstacle to surgery. On the other hand, the primary risk associated with surgery is the presence of infection accompanying the disease. For example, the operation of an inflamed gallbladder is more risky than the operation of non-inflamed gall bladder. Furthermore, irrespective of all these factors, hollow organ injury is a risk for almost every patient as in any laparoscopic surgery. However, it should be noted that these risks are less than 3% and most injuries are repaired during surgery and generally do not cause any problems.
SHOULD I HAVE EMERGENCY SURGERY? WHEN IS THE BEST TIME TO UNDERGO SURGERY?
If your gallbladder has a life-threatening inflammation and loss of viability and if there is a risk of perforation of the gallbladder, you should undergo emergency surgery. But you should know that this is very rare in today’s practice. The inflamed gallbladder requires hospitalization of the patient. First, the patient is restricted to eat, then intravenous fluid, electrolyte and antibiotic treatment is started. In this method, clinical improvement is achieved in the majority of patients. Inflammation of the gallbladder necessarily requires surgical treatment. However, there are different views on the timing of surgery. I agree with the widely accepted opinion that laparoscopic gallbladder surgery should be performed as soon as possible after the general condition of the patient has improved and this period should not exceed 48-72 hours. It should be noted that undesirable conditions (complications) may increase in patients over this period. Early surgery provides the advantage of performing definitive treatment in the short term. In this case, the time of hospitalization and return to work is short and the cost is low. This eliminates the need for a second hospitalization. The main drawback is the risk that the inflamed gallbladder cannot be operated laparoscopically, and this is a probability ranging from 10-15% today. Inflammation and related abdominal adhesions may prevent laparoscopic surgery, and in this case, surgery can be performed with open method.
Some surgeons do the treatment of the inflamed gallbladder in hospital but only with antibiotics and postpone the surgery, which is a permanent solution, to 6 weeks later. The most important advantage of this less accepted view is that the rate of laparoscopic initiation and laparoscopic continuation is extremely high, but requires a second hospitalization, and it should be kept in mind that there may be a risk of developing a new gallbladder attack during this delayed 6-week period.
In summary, in comparative studies and meta-analyzes; laparoscopic operation of the gallbladder at the first hospitalization in the early period is stated to be a safe method and it should be targeted to be operated within the first 48-72 hours, if this is not possible, the operation should be postponed for 6 weeks.
HOW DO GALLSTONES FORM?
Bile in the gallbladder can form a mud-like precipitate in the pouch, just like coffee grounds. Gallstones are formed by the accumulation of gall sludge and sediment which solidify around a nucleus. Gallbladder stones can combine to form larger stones, or they can be millimeter in size but many. There is a risk that small gallstones fall into the bile duct. Therefore, if gallstones are many and small in size, patients should be treated.
If the gallbladder stones are left untreated, gallstones falling into the bile duct may cause problems such as inflammation, pancreatic damage, jaundice, and abscess development.
WHAT ARE THE SYMPTOMS AND MAJOR COMPLAINTS OF GALLBLADDER DISEASES?
Gallstones often do not cause any symptoms. However, when the gallbladder becomes inflamed or occluded, it causes pain, nausea and sometimes vomiting. In addition, fever is a warning about the seriousness of the condition. If jaundice has developed, it should be evaluated by a surgeon as soon as possible.
Because stones in the gallbladder and a blockage in the bile ducts may have caused jaundice.
Pain typically begins after meals and lasts for about 1-2 hours. Abdominal pain and indigestion, which became evident after fatty meals, are recurrent.
HOW ARE GALLSTONES DIAGNOSED?
Ultrasonography is the first applied examination for all kinds of problems in gallbladder. With the help of ultrasound, which is almost the gold standard, problems such as stones, sludge or polyps can be recognized in the gallbladder. In addition, the liver and other vascular structures and bile ducts adjacent to the gallbladder are evaluated.
IF GALLSTONES ARE FORMED, WHICH TESTS SHOULD BE PERFORMED?
Liver function tests and complete blood count should be checked in patients with gallbladder stones or similar problems. These tests are hemogram, ALT, AST, ALP, GGT, Bilirubin, albumin, INR and aPTT.
DOES EVERY PATIENT HAVE TO BE OPERATED BECAUSE OF GALLSTONES?
Laparoscopic Cholecystectomy, Closed Surgery of Gallbladder
Gall bladder surgery is one of the most common abdominal operations today. In cases of gallstone, sand, and inflammation, the solution is usually possible with surgery.
Is every stone in the gallbladder operated? No, if the stones are large and do not cause inflammation in the gallbladder, surgery is not necessary. However, surgery may be necessary in the presence of small stones, especially if sludge has formed in the gallbladder.
Laparoscopic cholecystectomy is the gold standard for the treatment of gallbladder diseases. With the camera used in incisions as much as the keyhole incisions, gall bladder, liver, stomach and large intestines are displayed and gall bladder under the liver is removed. Gallbladder laparoscopic surgery takes about 20 minutes and is performed under general anesthesia. The patient is discharged on the following day. There is no special diet after gall bladder surgery.
Shoulder pain after gall bladder surgery
It is important to have right shoulder pain in the early postoperative period and to continue abdominal pain. There may be a leak from the duct between the liver and duodenum to which the gall bladder is attached. In such a case, it is necessary to evaluate the surgical site by ultrasound and, if necessary, by tomography and also to check the liver function tests.
Presence of polyp in the gallbladder
The development of polyps in the gallbladder is detected by ultrasound. Polyps are important because they pose a risk for cancer development. Multiple and smaller than 1 cm and large ones alone are risky.
Gallbladder stones and pancreatitis
The pancreas, an organ located in the neighborhood of the gallbladder, is connected to the bile ducts. It helps digest foods by secreting enzymes involved in digestion just like gall bladder. The pancreas may be inflamed in the presence of stones in the biliary tract. In this case, the patient should definitely be hospitalized and treated.
Pancreatitis is the name given to the inflammation of the pancreas. Although it develops mostly due to millimetric stones in the gallbladder, it may also develop due to alcohol use.
WHY IS IT IMPORTANT?
When pancreatic inflammation develops, a mild condition is often encountered with 80%, but in one out of five patients the condition may turn into a serious clinical problem.
HOW IS PANCREATITIS DIAGNOSED?
Diagnosis is made by examining blood levels of some enzymes secreted from pancreas, liver function test results and ultrasound examination. If necessary, detailed examination with CT and MRI may be required.
HOW IS PANCREATITIS TREATED?
Pancreatic inflammation must be treated, inpatient. In patients with mild clinical presentation, recovery is almost complete, while some patients may develop recurrent inflammatory conditions. Cause-oriented treatment is done. For example, if there is pancreatitis due to stones in the gallbladder, gallbladder surgery and ERCP should be performed if necessary. However, in patients with a healthy gallbladder and without a stone in the gallbladder, treatment is performed by medical treatment, not by surgery.
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